Bradycardia/Disautonomia

My heart slows way down when I am in REM sleep. Night time monitoring shows my heart rate falls well below 30 BPM and then pauses for 3-6 seconds per beat several times. I often wake up from these events feeling like death warmed over. I have in the past 3 years had 5 blood clots( 1 DVT) which I believe are related to the slow night time heart rate.

I have had a several other medical issues over the past 3 year (not enough space to talk about them here). I've been to well over 20 doctors, and been through the "you’re suffering from anxiety and depression" thing so much it makes me ill to think about it (how doctors can think patients are so stupid that they cannot identify the cause of their own anxiety depression is just mind boggling). I stumbled on dysautonomia as a possible explanation as I researched the vagus nerve.

Any thoughts on whether I should continue to explore dysautonomia and where to start?

Most of what I've read on dysautonomia pertains to POTS and GI issues, but my symptoms don't really fit into those categories. I have few periods of light headedness and virtually no GI problems. I believe any lighthededness that I have experienced is associated with the anxiety rather than of orthostatic origin.

I'm hoping to find another explanation for the bradycardia, otherwise I think I'm headed for a pacemaker even though my cardiologist currently is not recommending one even though I believe these nighttime heart pauses are damaging.

One thing I have noticed is that lack of sleep, and sometimes intense exercise, exacerbates my night time bradycardia. My take is that sleep deprivation tends to cause longer periods of REM sleep when I do sleep. I do occasionally experience bradycardia (heart rate into the 40s) when I am sleepy but awake. My heart rate responds well when exercising. I've never had a problem with it during the day when I am well rested.

It sounds like you have had a frustrating experience and still have many issues/questions left unanswered. I'm afraid I cannot provide you with an accurate or complete answer for what sounds like a very complicated situation over the internet with limited information. However, I can say that a heart rate below 30 at any time is highly abnormal. The "pauses" you have overnight of 3-6 seconds may be reflective of your extremely slow heart rate rather than true pauses related to complete or intermittant heart block (where conduction through the atrio-ventricular node or down the bundles of His is transiently and totally impaired). Dysautonomia is sort of a catch all term for several disorders related to abnormal conduction through the nervous system. Isolated conduction abnormalities in the heart without other evidence of abnormal nerve function elsewhere in the body suggests a problem that is not necessarily systemic and unlikely to be dysautonomia. If you have other symptoms that would suggest this diagnosis (sounds like you have multiple other medical problems), then your slow heart rate may indeed be related to this. I would suspect that your lightheadedness is more associated with your profound bradycardia (slow heart rate) rather than anxiety. If not done already, you should have a Holter monitor, regular EKGs, echocardiogram (ultrasound of the heart), and possibly tilt-table testing to check your nervous system function due to your periods of lightheadedness (especially if you have ever lost consciousness or came close to doing so).
I hope your physicians can work with you to find a definitive answer. A heart rate that slow is never normal and you may need to seek another opinion from a different cardiologist if you are not feeling like your questions are being totally answered.

Thank you for the thoughtful response. I have had all the tests that you have mentioned except a tilt-table test. Note that my periods of lightheadeness have subsided with getting the anxiety over all this in check. I have not had such an event in many months.

I've working (that amounts to sending e-mails asking questions) with my primary care doctor, EP cardiologist, regular cardiologist, and hemotologist for months on this. My latest round of questions for them focus on how will we know when it is time for a pacemaker and what can we do to prevent me from ever getting there. It does drive me a little crazy that I need to ask such questions because you would think they would be the kind of questions they ask themselves and would provide me the answers with me asking (sorry for the complaints, its just that the blase attitude and lack of proactivity of all the doctors I see is so very frustrating).

Correction: It does drive me a little crazy that I need to ask such questions because you would think they would be the kind of questions they ask themselves and would provide me the answers withOUT me asking.

Also wanted to mention that so far my heart is very healthy. My other issue is the one that kicked all this off: mysterious tremor like sensations (nothing visible moving) that to me feel very much like O2 deprivation - -its the same feeling I get after aerobic activity, but without all the breathing. When I make such statements doctors just just look at me with an uninterested look on their faces. Evidently that symptom has no import to them. That symptoms was accompanied with chest pain (which was not really an issue for me since I've had chest pain off an on for years and multiple prior stress tests, EKGs, echo cardiograms revealed nothing by mitral valve prolapse). The combination of the tremor feelings, chest pain, anxiety, and lightheadness put me in the emergency room a couple of times. That led to a cardiac catheterization (which I believed was overkill because there is no heart disease in my family, I'm fit - used to run a lot - low BP, low cholesteral - at least that was the case when all this started, my fitness, BP, and cholesteral have all worsened since the start of this because of the inactivity and stress that it has caused) - revealed perfectly smooth arteries. Following the cath I had a blood clot in my arm where the IV was, then a DVT in my left calf and a PE. I believed the other clots in my left 've worn heart event monitors 3 times which revealed nothing but a few PVCs. A year later I wore another one that communicated to a service via a cell phone and that's when it was discovered that my heart rate was dropping low when I sleep. This was followed by an in home sleep study which revealed the same thing, but no sleep apnea. This was later followed by a Holter monitor which revealed the same thing. During this time the veins affected by the DVT have occluded twice, and I have had two other superficial vein clots. Until now, I have blamed the arm clot and DVT on the fact that I was not put back on an IV after the cath to flush the contrast agent from my blood stream. I blamed all the others which were in my left leg on impaired blood flow and damaged valves from the original DVT. All of these instances of clots have been preceded by a period of being short on sleep and more intense exercise than normal. I'm 55 years old, male, and have had no major health problems in my life except appendicitis and what I have described here.

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